Provider Demographics
NPI:1508867664
Name:TIMBERT, DAVIS SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:SCOTT
Last Name:TIMBERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1240 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5170
Mailing Address - Country:US
Mailing Address - Phone:770-507-5055
Mailing Address - Fax:770-507-5880
Practice Address - Street 1:1240 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5170
Practice Address - Country:US
Practice Address - Phone:770-507-5055
Practice Address - Fax:770-507-5880
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAGA037404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02BBGLJMedicare ID - Type Unspecified
GAG24541Medicare UPIN
GA00697474EMedicaid